Cite this article as: BMJ, doi:10.1136/bmj.38744.672616.

AE (published 17 February 2006)

Research

Treatment of low back pain by acupressure and physical therapy:

randomised controlled trial
Lisa Li-Chen Hsieh, Chung-Hung Kuo, Liang Huei Lee, Amy Ming-Fang Yen, Kuo-Liong Chien, Tony Hsiu-Hsi Chen

Abstract reducing low back pain, the type of outcome measurement has
varied from study to study. To establish a standard instrument for
Objective To evaluate the effectiveness of acupressure in terms comparisons across studies, a standardised “core” set of
of disability, pain scores, and functional status. questions and questionnaires (referred to here as standard
Design Randomised controlled trial. outcome measures) has been proposed by an international pro-
Setting Orthopaedic clinic in Kaohsiung, Taiwan. gramme on primary care management of low back pain since
Participants 129 patients with chronic low back pain. 1998.8
Intervention Acupressure or physical therapy for one month. We aimed to do a randomised controlled trial using validated
Main outcome measures Self administered Chinese versions of Chinese versions of the standard outcome measures to compare
standard outcome measures for low back pain (primary the efficacy of acupressure with that of physical therapy in allevi-
outcome: Roland and Morris disability questionnaire) at ating low back pain and to provide a base for comparison across
baseline, after treatment, and at six month follow-up. international studies.
Results The mean total Roland and Morris disability
questionnaire score after treatment was significantly lower in
the acupressure group than in the physical therapy group Methods
regardless of the difference in absolute score ( − 3.8, 95% Study participants
confidence interval − 5.7 to − 1.9) or mean change from the The study took place between 8 January and 12 May 2004, with
baseline ( − 4.64, − 6.39 to − 2.89). Acupressure conferred an follow-up until 12 November 2004. We selected 188 participants
89% (95% confidence interval 61% to 97%) reduction in from among the outpatients of a specialist orthopaedic clinic in
significant disability compared with physical therapy. The Kaoshiung, Taiwan, which offered standardised physical therapy.
improvement in disability score in the acupressure group Patients were eligible if they were aged 18 years and older; they
compared with the physical group remained at six month had had chronic low back pain for more than four months, as
follow-up. Statistically significant differences also occurred diagnosed by a senior orthopaedic specialist; their chronic low
between the two groups for all six domains of the core back pain was not caused by systemic or organic diseases,
outcome, pain visual scale, and modified Oswestry disability cancers, or psychiatric diseases; they were not pregnant; they had
questionnaire after treatment and at six month follow-up. no acute severe pains needing immediate treatment or surgery;
Conclusions Acupressure was effective in reducing low back and they had no contraindication to acupressure (that is, no
pain in terms of disability, pain scores, and functional status. open wound). All participants gave written informed consent.
The benefit was sustained for six months.
Sample size determination
We did a pilot trial before the main study to obtain score means
Introduction
and standard deviations with the Roland and Morris disability
Low back pain is a common health problem worldwide. In addi- questionnaire, modified Oswestry disability questionnaire, and
tion to conventional physical therapy, acupuncture—classified in visual analogue scale for estimating sample sizes. We took the
group 1 of the complementary and alternative therapies (profes- Roland and Morris disability questionnaire as the primary
sionally organised alternative therapies)1—has been shown to be outcome. To detect the mean difference in score between the two
effective in alleviating various types of pain.2 Its efficacy for low groups (the mean scores in the pilot study were 28.4 (SD 16.9)
back pain remains elusive, however.3 Acupressure, another com- for the acupressure group and 48.0 (SD 22.9) for the physical
plementary and alternative therapy, has had increasing attention, therapy group), with a significance level of 5% (two tailed) and
as it is manipulated with the fingers instead of needles on the statistical power of 80%, we needed 65 participants in each arm.
acupoints and has been used for relieving pain, illness, and inju-
ries in traditional Chinese medicine.4 Randomisation
The efficacy of acupressure in relieving pain associated with A research assistant independently randomised participants by
low back pain has been shown by a randomised controlled trial.5 using a predetermined random table, which was not decoded
However, the outcomes in that study were assessed by until the intervention was assigned. After exclusion of ineligible
description of pain character and failed to take into account patients, 129 (69%) patients aged between 18 and 81 met our eli-
functional status and disability as recommended by most low gibility and were randomly allocated to two arms: 64 patients in
back pain researchers.6 7 Although trials have investigated the the acupressure group and 65 patients in the physical therapy
efficacy of physical therapy, acupuncture, and acupressure in group.

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Interventions post-treatment and six month follow-up assessments were iden-

Each participant received six sessions within one month. One tical to those at baseline.
senior acupressure therapist gave each session of acupressure As Roland and Morris disability questionnaire score is a
treatment to ensure a uniform technique and consistent experi- skewed, non-normal distribution, we used the Wilcoxon rank
ence. The participants in the physical therapy group received the sum test to assess the difference between the two groups.9 We
routine physical therapy offered by the orthopaedic specialist used the non-parametric jack-knife method to calculate 95%
clinic, including pelvic manual traction, spinal manipulation, confidence intervals.10 We used analysis of covariance to assess
thermotherapy, infrared light therapy, electrical stimulation, and the differences and 95% confidence intervals between the two
exercise therapy, as decided by the physical therapist. groups in visual analogue scale pain scores and pain scores
measured by the core outcome measures and Oswestry disability
Blinding questionnaire, with adjustment for pretreatment score alone or
Blinded treatment of acupressure is impractical. To reduce the together with other possible baseline variables such as duration
“Hawthorne effect” (whereby patients with known higher pain of low back pain.9 We used logistic regression models to estimate
scores receive more effort from the therapist), both the acupres- the odds ratios and 95% confidence intervals of having
sure therapist and the physical therapists were blind to pretreat- significant disability as measured by the Roland and Morris dis-
ment assessment. We asked patients, without referring to the ability questionnaire, with adjustment for pretreatment score
pretreatment assessment, to assess the post-treatment pain alone or together with other possible baseline variables. We
scores and ratings by filling out the questionnaires or by applied cumulative logit models to the ordinal property of
telephone interview immediately after completing six treatment disability defined by Oswestry disability questionnaire to
sessions or the one month period, whichever came first. The estimate incremental odds ratios and 95% confidence intervals.11
research assistant who did the post-treatment and six month We used SAS version 9 for statistical analyses.
follow-up interviews by telephone was also blind to pretreatment
assessment and was told beforehand not to ask the participants
about the details of the intervention in order to remain blind to Results
the intervention as far as possible. In addition, to avoid observa- The figure shows a summary of enrolment, randomisation, loss
tion bias, the assessor was blind to intervention group before to follow-up, and assessment. Two participants in the
analysis of data was complete. acupressure group and five in the physical therapy group
refused to receive the designated intervention. Two participants
Outcome measurements
in each group switched to receive the treatment of the opposite
Although the Chinese versions of the standard outcome
group. Table 1 shows the baseline characteristics in the two treat-
measures comprise four components—core outcome measures,
ment groups; no differences existed in demographic, educa-
Roland and Morris disability questionnaire, Oswestry disability
tional, or occupational aspects.
questionnaire, and EuroQoL—we used only the first three,
because the patients in the pilot study found EuroQoL difficult Roland and Morris disability questionnaire
to use. We also used a visual analogue scale for recording pain The mean total Roland and Morris disability questionnaire score
scores. We asked participants in each group to provide baseline after treatment was significantly lower in the acupressure group
information, including date of birth, sex, marital status, than in the physical therapy group, regardless of the difference in
occupation category, educational level, and sleeping quality, and absolute score ( − 3.8, 95% confidence interval − 5.7 to − 1.9) or
to complete the Chinese version of the standard outcome meas- mean change from baseline ( − 4.64, − 6.39 to − 2.89) (table 2).
ures at enrolment. We used separate sets of questionnaires for Acupressure conferred an 89% (95% confidence interval 61% to
pretreatment, post-treatment, and six month follow-up assess- 97%) reduction in significant disability compared with physical
ments by patients and research assistant. To avoid recall bias, only therapy after adjustment for degree of disability at baseline. The
the reference number and participant’s name were shown on mean difference in total score between the two groups after
these questionnaires, without revealing the previous assessment. treatment remained statistically significant (P < 0.05) after
We took Roland and Morris disability questionnaire as the adjustment for pretreatment score or disability together with
primary outcome and the other measures as secondary other baseline characteristics shown in table 1.
outcomes. Given the difference in rate of significant disability (table 2),
When evaluating the treatment efficacy, we divided the total the estimated number needed to be treated with acupressure to
scores measured by the Roland and Morris disability reduce cases with severe disability by one was 5.98. As seen in
questionnaire into two score scales for measuring the degree of table 2, the improvement in Roland and Morris disability
disability, taking 0-12 as minimal disability and 13-24 as questionnaire score in the acupressure group compared with the
significant disability. We used the modified version of the physical group still remained at the six month follow-up. The
Oswestry disability questionnaire used in the American number needed to treat with acupressure was 9.31.
Academy of Orthopaedic Surgeons lumbar cluster, which has
nine questions with six ratings. We summed ratings on each item Core outcome measures and visual analogue scale
as total scores for each patient. We divided the total scores into After adjustment for pretreatment score (comparison 1 in table
five grades for measuring the degree of disability, taking 0-11 as 3), the differences in mean scores for core outcome measures in
minimal disability, 12-22 as moderate disability, 23-32 as severe the acupressure group were significantly different from those in
disability, 33-43 as crippled, and ≥ 44 as bed bound. the physical therapy group. Mean scores were lower in the
acupressure group for the items “low back pain,” “leg pain,” “pain
Statistical analysis interferes with normal work,” “days cut down on doing things,”
For comparisons of baseline variables, we used Student’s t test for and “days off from work/school.” Mean scores were higher in the
continuous variables and the
2 test for categorical variables. acupressure group for the items “satisfaction of life with the
Analysis was by intention to treat. For participants lost to follow- symptoms” and “satisfaction with previous treatment.” The mean
up, we conservatively assumed that the values at the scores for the pain visual scale and sleeping with low back pain

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Table 1 Baseline characteristics of participants by treatment group. Values Table 2 Roland and Morris disability questionnaire (RMDQ) scores
are numbers (percentages) unless stated otherwise pretreatment, post-treatment, and at six month follow-up
Acupressure Physical therapy Sums of RMDQ Physical
Variable (n=64) (n=65) scores/ordinal Acupressure therapy
Mean (SD) age (years) 50.2 (13.8) 52.6 (17.2) scorings (0-24) (n=64) (n=65) Comparison 1† Comparison 2‡
Male sex 21 (33) 17 (26) Pretreatment
Marital status: Mean (SD) total score 10.9 (6.2) 10.0 (5.3) — —
Single 10 (16) 11 (17) Degree of disability
(No):
Married 54 (84) 54 (83)
Minimal (0-12) 36 45 — —
Education:
Significant (13-24) 28 20
College and above 17 (27) 14 (21)
Post-treatment
Senior high school 20 (31) 16 (25)
Mean (SD) total score 5.4 (5.0) 9.2 (5.8) −3.8*** −4.64***
Junior high school or below 27 (42) 35 (54)
(−5.7 to −1.9) (−6.39 to −2.89)
Occupation:
Degree of disability
Household keeper 18 (28) 16 (25) (No):
Office worker 17 (27) 8 (12) Minimal (0-12) 56 46 OR=0.11**
—
Heaver labour 9 (14) 8 (12) Significant (13-24) 8 19 (0.03 to 0.39)
Other 20 (31) 33 (51) Six month follow-up
Median (range) time since onset of pain (years) 3.3 (0.2-33.3) 1.6 (0.2-34.3) Mean (SD) total score 2.2 (3.2) 6.7 (5.5) −4.5*** −5.36***
Median (range) length of latest pain period 14.5 (0.02-360) 12 (0.25-432) (−6.1 to −2.9) (−7.21 to −3.52)
(months) Degree of disability
(No):
Minimal (0-12) 63 57 OR=0.07*
were lower in the acupressure group than in the physical therapy (0.01 to 0.57)
—
Significant (13-24) 1 8
group. The differences between the two groups remained statis-
†Absolute difference between groups analysed by Wilcoxon rank sum test for total scores,
tically significant (P < 0.05) after adjustment for pretreatment 95% confidence interval calculated by non-parametric jack-knife method; odds ratio (OR)
score and other baseline characteristics. In terms of mean (95% confidence interval) of showing significant degree of disability for acupressure
compared with physical therapy, analysed by multiple logistic regression.
change from baseline, the benefit was also greater in the
‡Difference (95% confidence interval) in mean change in score from baseline.
acupressure group for all variables (comparison 2 in table 3). *P<0.05.
The statistically significant improvement remained or even **P<0.01.
***P<0.0001.
increased at the six month follow-up (table 3).

Modified Oswestry disability questionnaire

The mean total Oswestry disability questionnaire score after Given the difference in rate of significant disability between
treatment was significantly lower in the acupressure group than the two groups (table 4), the estimated number needed to treat
in the physical therapy group, regardless of the difference in with acupressure to reduce the degree of disability by one grade
absolute score ( − 5.34, − 7.62 to − 3.05) or mean change from was 6.15. As seen in table 4, the improvement in Oswestry
baseline ( − 6.81, − 9.49 to − 4.12) (table 4). As regards disability disability questionnaire score in the acupressure group
classified by five grades, the odds ratio of increasing one grade of compared with the physical group remained at the six month
disability was 0.22 (95% confidence interval 0.11 to 0.48; follow-up. The number needed to treat with acupressure was
P = 0.0001) for the acupressure group. The differences between 4.58.
the two groups remained significant (P < 0.05) after adjustment
for pretreatment score or disability in conjunction with other
baseline characteristics.

Patients enrolled (n=188)

Did not meet inclusion criteria (n=30)

Met inclusion criteria (n=158)

Unable to follow study protocol (n=29)

Completed questionnaires
and randomised (n=129)

Allocated to acupressure group (n=64) Allocated to physical therapy (n=65)

Received acupressure as allocated (n=60) Received therapy as allocated (n=58)
Refused to receive acupressure (n=2) Refused to receive physical therapy (n=5)
Changed to physical therapy group (n=2) Changed to acupressure group (n=2)

Lost to follow-up after one month (n=2) Lost to follow-up after one month (n=6)
Lost to follow-up after six months (n=9) Lost to follow-up after six months (n=11)

Pain score assessment after one month (n=63) Pain score assessment after one month (n=59)
Pain score assessment after six months (n=55) Pain score assessment after six months (n=54)

Trial profile

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Table 3 Mean (SD) core outcome measures pretreatment, post-treatment, and at six month follow-up
Pre-treatment Post-treatment Six month follow-up
Core outcome
measures and Physical Physical Physical
related indicators Acupressure therapy Acupressure therapy Acupressure therapy
(n=64) (n=65) (n=64) (n=65) Comparison 1† Comparison 2‡ (n=64) (n=65) Comparison 1† Comparison 2‡
Degree of “how
bothersome”:
Low back pain 2.97 (1.01) 2.78 (0.96) 2.11 (0.86) 2.57 −0.53*** −0.64*** 1.59 (0.73) 2.17 −0.62*** −0.76***
(0.83) (−0.80 to −0.28) (−0.97 to −0.32) (0.89) (−0.90 to −0.35) (−1.13 to −0.39)
Leg pain 2.78 (1.16) 2.74 (1.11) 1.94 (0.85) 2.52 −0.60*** −0.63** 1.48 (0.71) 2.15 −0.68*** −0.71**
(0.97) (−0.87 to −0.34) (−0.97 to −0.29) (0.97) (−0.96 to −0.41) (−1.10 to −0.32)
Pain interferes 2.78 (1.11) 2.45 (0.98) 2.05 (0.88) 2.38 −0.50** −0.67** 1.61 (0.75) 2.23 −0.70*** −0.96***
with normal work (1.01) (−0.78 to −0.21) (−1.02 to −0.33) (0.88) (−0.98 to −0.42) (−1.35 to −0.57)
Satisfaction of life 1.39 (0.68) 1.57 (0.66) 2.38 (1.27) 1.97 0.46* 0.58** 3.63 (1.16) 2.95 0.69** 0.85**
with symptoms (1.04) (0.05 to 0.86) (0.15 to 1.02) (1.24) (0.27 to 1.11) (0.38 to 1.32)
Days cut down on 5.0 (10.5) 3.4 (8.6) 1.6 (4.7) 4.0 (9.8) −3.16** −3.99** 0.4 (2.6) 2.6 (8.0) −2.48* −3.70*
doing things (−5.38 to −0.93) (−6.83 to −1.15) (−4.45 to −0.50) (−6.98 to −0.42)
Days off from 4.2 (9.5) 3.3 (8.6) 1.5 (5.4) 3.5 (9.3) −2.45* −2.87* 0.6 (3.8) 2.5 (8.0) −2.15* −2.79
work/school (−4.59 to −0.31) (−5.51 to −0.23) (−4.22 to −0.09) (−5.94 to −0.35)
Satisfaction with 2.06 (1.39) 2.13 (1.68) 4.12 (1.22) 3.06 1.25*** 1.68*** 4.39 (0.75) 3.15 1.39*** 1.83***
previous (1.38) (0.82 to 1.68) (1.17 to 2.20) (1.14) (1.02 to 1.76) (1.37 to 2.29)
treatment
Pain visual scale (0 58.8 (17.88) 57 (17.83) 30.6 (21.75) 48.0 −18.38*** −19.27*** 16.1 (17.4) 41.4 −25.92*** −27.12***
to 100) (23.4) (−25.60 to −11.17) (−27.04 to −11.5) (24.6) (−33.06 to −18.77) (−35.3 to −18.94)
Sleeping with low 2.17 (0.86) 2.03 (0.97) 1.44 (0.59) 1.85 −0.46*** −0.55** 1.16 (0.44) 1.72 −0.61*** −0.71***
back pain (0.85) (−0.69 to −0.24) (−0.84 to −0.26) (0.84) (−0.82 to −0.39) (−1.02 to −0.39)
†Absolute difference (95% confidence interval) between groups by analysis of covariance.
‡Difference (95% confidence interval) in mean change in core outcome measures from baseline.
*P<0.05.
**P<0.01.
***P<0.0001.

Discussion Table 4 Modified Oswestry disability questionnaire (ODQ) scores

pretreatment, post-treatment, and at six month follow-up
This study shows that acupressure is more efficacious in alleviat-
Sums of ODQ Physical
ing low back pain than is physical therapy, as measured by pain scores/ordinal Acupressure therapy
visual analogue scale, core outcome measures, Roland and Mor- scorings (0-54) (n=64) (n=65) Comparison 1† Comparison 2‡
ris disability questionnaire, and Oswestry disability question- Pretreatment
naire. The results support the conclusion of the previous 24.4 21.1 (8.7)
Mean (SD) total score
(10.0)
randomised controlled clinical trial on low back pain treated by
Degree of disability
acupressure.5 Acupressure may thus be useful for reducing pain (No):
and improving body function and level of disability in low back Minimal (0-11) 4 3
pain. Moderate (12-22) 29 42
Severe (23-32) 14 13
Outcome measures used Crippled (33-43) 15 5
Most of the domains of the core outcome measures were able to Bed bound (≥44) 2 2
distinguish the difference between the acupressure group and Post-treatment
the physical therapy group, irrespective of absolute change or Mean (SD) total score 17.0 20.6 (8.8) −5.34*** −6.81***
mean change from baseline at post-treatment and six month (7.6) (−7.62 to −3.05) (−9.49 to −4.12)
follow-up assessments. The Roland and Morris disability Degree of disability
(No):
questionnaire has been considered an outcome measure
Minimal (0-11) 17 7 OR=0.22**
sensitive to changes in clinical status for the study of low back (0.11 to 0.48)
pain.12 13 In our study, we saw statistically significant treatment Moderate (12-22) 32 37
differences with this questionnaire. Results for the Oswestry dis- Severe (23-32) 12 15
ability questionnaire score also showed functional improvement Crippled (33-43) 3 4
with acupressure irrespective of whether the score was classified Bed bound (≥44) 0 2
into five ordinal categories or modified by a simple summation Six month follow-up
scoring method.14 Mean (SD) total score 12.2 17.9 (8.1) −6.03*** −7.99***
(4.9) (−8.22 to −3.84) (−10.8 to −5.17)
The World Health Organization recommended that the
Degree of disability
visual analogue scale should be included as an outcome measure (No):
in all studies on low back pain,15 so we included this measure in Minimal (0-11) 39 17 OR=0.11***
the study. Sleep disturbance is a common complaint of patients (0.04 to 0.27)

with low back pain, and we included it as a reference indicator; it Moderate (12-22) 22 33
Severe (23-32) 2 11
showed a significant difference between the two groups in abso-
Crippled (33-43) 0 3
lute change and mean change from baseline at the post-
Bed bound (≥44) 0 0
treatment and six month follow-up assessments.
†Absolute difference (95% confidence interval) between groups by analysis of covariance.
Limitations of the study ‡Difference (95% confidence interval) in mean change in core outcome measures from
baseline.
Three concerns about the study should be clarified. Firstly, the **P<0.01.
efficacy of acupressure in pain relief might be attributed to a psy- ***P<0.0001.

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chological effect emerging between patients and therapist

during therapy. However, we believe that such a confounding
What is already known on this topic
effect caused by interaction or a doctor-patient relationship is Acupressure is efficacious in alleviating low back pain in
unlikely to affect the results, because people who seek physical terms of pain character description
therapy generally have a strong desire for orthodox/Western
medicine, the therapists in both groups were blind to the results Little is known about its efficacy in reducing low back pain
of pretreatment assessments, and the use of Roland and Morris assessed with standard outcome measures
disability questionnaire and Oswestry disability questionnaire
was mainly to assess functional status and disability, which should
What this study adds
be less affected by the psychological effect than subjective meas- Acupressure was effective in reducing low back pain in
ures of pain. terms of pain scores, functional status, and disability
Secondly, 20 (15.5%) patients were lost to follow-up at six
months. We do not believe that this would have had much influ- The effect was not only seen in the short term but lasted for
ence on the result. However, the problem might be ameliorated six months
by using an intention to treat method that included patients lost
to follow-up in the analysis. As mentioned before, we substituted Ethical approval: The study protocol was approved by an ethics committee
missing data for patients lost to follow-up with baseline or post- of the specialist orthopaedic clinic.
treatment data by assuming no change since last contact.
1 Mills SY. Regulation in complementary and alternative medicine. BMJ 2001;322:158-
Finally, the effectiveness of any manipulation therapy is 60.
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alternative medicine use in the United States, 1990-1997: results of a follow-up national
The selection of treatment modality and technique to be applied survey. JAMA 1998;280:1569-75.
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physical therapy and acupressure, even though standardised controlled trials. Arch Intern Med 1998;158:2235-41.
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procedures were established. Ensuring comparability between systems. BMJ 1997;315:115-7.
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back pain treated by acupressure and physical therapy. Prev Med 2004;39:168-76.
should not be a serious problem because the technique has been 6 Roland M, Fairbank J. The Roland-Morris disability questionnaire and the Oswestry
well established in orthodox/Western medicine. We avoided disability questionnaire. Spine 2000;25:3115-24.
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13.
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be used in other populations. How acupressure can be 1980;42:109-42.
12 Suzukamo Y, Fukuhara S, Kikuchi S, Konno S, Roland M, Iwamoto Y, et al. Validation
generalised to patients with low back pain is the subject of ongo- of the Japanese version of the Roland-Morris disability questionnaire. J Orthop Sci
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This randomised controlled clinical trial has shown the efficacy successful spinal high-velocity thrust manipulation in individuals with low back pain.
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15 Ehrlich G, Khaltaev NG. Low back pain initiative. Geneva: World Health Organization,
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functional status. The results provide a base for comparison (Accepted 10 January 2006)
across international studies. doi 10.1136/bmj.38744.672616.AE

We thank Richard A Deyo for granting permission to use the standardised

“core” set of questions and questionnaires. Institute of Preventive Medicine, College of Public Health, National Taiwan
University, Taipei, Taiwan
Contributors: TH-HC was responsible for study design and implementa-
Lisa Li-Chen Hsieh PhD student
tion, data collection and analysis, and interpretation of the findings and Amy Ming-Fang Yen assistant professor
drafted the paper. LL-CH, C-HK, and LHL contributed to study implemen- Kuo-Liong Chien associate professor
tation, data collection, interpretation of findings, and writing the draft. Tony Hsiu-Hsi Chen professor
AM-FY and K-LC contributed to management and analysis, interpretation Hsin Kao Mei Orthopedic Special Clinic, Kaohsiung, Taiwan
of findings, and revision of the manuscript. TH-HC and LL-CH are Chung-Hung Kuo chief and orthopedist
guarantors.
Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Funding: None. Liang Huei Lee attending medical neurologist
Competing interests: None declared. Correspondence to: Tony Hsiu-Hsi Chen stony@episerv.cph.ntu.edu.tw

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